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PubMed1986

[Management of combination injuries of the femur shaft and femoral neck fractures with a locking nail. Multicenter study of 26 cases from 4 trauma clinics].

Twenty-six patients with femoral shaft- and ipsilateral neck-fracture, treated in four different hospitals, have been analysed. The majority of these fractures was treated by a distally locked dynamic nail and fixation of the femoral neck by two or three lag-screws. In some cases a "contralateral" nail with a proximal locking screw in the femoral neck was used. Results are excellent without non-union or mal-union. Only one case of avascular necrosis occurred in an 68 years old patient. Interlocking intramedullary nailing certainly has its place in the treatment of associated femoral shaft- and neck-fractures. This closed method presents a stable fixation and permits early mobilisation and joint-function.

Bone Nails↗
PubMed1986

Effect of calcium and stanozolol on calcitonin secretion in patients with femoral neck fracture.

The role of calcitonin in the aetiology of postmenopausal osteoporosis remains uncertain. Oestrogen, an established therapy for postmenopausal osteoporosis, has been shown to enhance calcitonin secretion. In order to assess whether two other osteoporotic drug treatments, oral calcium and stanozolol (an anabolic steroid), may also affect calcitonin secretion, 20 elderly women with femoral neck fracture were randomly selected to receive either 880 mg calcium or 5 mg stanozolol daily for 12 weeks. Basal calcitonin and serum calcium were not altered significantly by either treatment. The calcitonin response to a 10 min infusion of calcium was enhanced following treatment with oral calcium but not stanozolol. This suggests one possible mechanism of action whereby calcium may exert its antiresorptive effect on bone and supports the use of oral calcium in the treatment of postmenopausal osteoporosis.

Aged↗
PubMed1992

Anesthetic techniques during surgical repair of femoral neck fractures. A meta-analysis.

Fracture of the hip typically occurs in older women. These patients usually have serious accompanying chronic illnesses. There is a difference of opinion as to the choice of regional versus general anesthesia for surgery in these patients. This meta-analysis compared survival of patients with traumatic femoral neck fractures undergoing operative repair during regional or general anesthesia. The data sources were articles comparing regional and general anesthesia from peer reviewed journals. Thirteen randomized controlled trials were found. Besides 1-month mortality, variables used were estimated operative blood loss and the incidence of deep venous thrombosis. For dichotomous outcomes, two effect measures were calculated: the difference in probabilities and the odds ratio. For blood loss, a continuous variable, the effect measure was the mean difference in blood loss. A random-effects Bayesian meta-analysis was used to combine study data, estimate parameters and create 95% confidence intervals. Only the incidence of deep venous thrombosis was clearly greater for patients receiving general anesthesia, being 31 percentage points higher than for patients receiving regional anesthesia. By the odds ratio, deep venous thrombosis was almost four times more likely following general anesthesia. There was no difference in estimated operative blood loss. By probability difference, mortality was a non-significant 2.7 percentage points less following regional anesthesia. By odds ratio effect measure, death was 1.5 times more likely following general anesthesia, but the lower bound of the 95% confidence interval was close to 1. Meta-analysis does not allow a conclusion that important differences in mortality exist between regional and general anesthesia for traumatic hip fracture surgery.

Aged↗
PubMed2005

Femoral neck fractures.

Despite the tremendous advances in the science and practice of orthopaedic surgery, anesthesia, and perioperative care, repair of displaced fractures of the neck of the femur is still associated with complications in up to one third of patients. The risk of nonunion and osteonecrosis in particular is virtually the same today as in the 1930s. Recent data from well-designed outcome studies now indicate that the most predictable, durable, and cost-effective procedure for an active elderly patient with a displaced femoral neck fracture is total joint arthroplasty; however, not all patients are candidates for this procedure, and the potential complications of arthroplasty, including mortality, may be more difficult to manage and more severe than those associated with internal fixation. The laudable goal of obtaining fracture healing and maintenance of a viable femoral head can be successfully achieved in a number of patients.

Arthroplasty, Replacement, Hip↗
PubMed1996

[Painless femoral neck fracture in a patient with multiple sclerosis].

We describe a patient with multiple sclerosis who suffered a painless hip fracture. She was admitted to the hospital three weeks after falling on her left hip. She had been unable to walk after the trauma, but had had no pain. The condition was initially misinterpreted as multiple sclerosis schub. X-ray examination showed fracture of the left femoral neck, and by the time she was admitted to hospital the patient was paretic. She has improved substantially after an operation involving cementless total hip arthroplasty. Painless fractures in patients with multiple sclerosis may be confused with exacerbations of their neurological disease.

Adult↗
PubMedDate not supplied

Low field magnetic resonance imaging of femoral neck fractures.

Fourteen patients with cervical hip fractures were treated with internal fixation using titanium screws. The femoral head vitality was evaluated with 99Tcm-MDP scintigraphy and scintimetry within 2 weeks postoperatively and by serial low field magnetic resonance imaging (MR). Two patients with reduced radionuclide uptake (femoral head ratio less than 1.0) developed radiographic signs of femoral head necrosis. MR disclosed the definite area of the necrosis at 2 and 12 months after fracture, respectively. In three of the patients with a high scintimetric uptake (femoral head ratio greater than or equal to 1.0), MR revealed a focal decrease of the signal intensity in the femoral head or neck at 2, 3 and 7 months after fracture, respectively. The radiographs in one of these patients were normal at 7 months after fracture. The second one showed signs of necrosis at 16 months and the last one developed delayed/non-union. With a non-ferromagnetic osteosynthesis the healing course after femoral neck fracture can be studied with low field MR equipment without disturbing artifacts. The time period between ischaemia and definite abnormalities on MR may embrace several months.

Aged↗